Down Syndrome

Down Syndrome and Obesity

Obesity has been a rising trend in America (Rubin, Rimmer, Chicoine, Braddock, & McGuire, 1998).  The prevalence of obesity from 2015 to 2016 was 39.8% of the general population, affecting as many as 93.3 million American adults (Center for Disease Control and Prevention, 2018). People who are overweight or obese are at an increased risk for serious health conditions such as Type 2 diabetes, stroke, cardiovascular disease, and other detrimental health conditions (Esposito, MacDonald, Hornyak, & Ulrich, 2012).  It is also one of the leading causes of premature death that could be preventable (Center for Disease Control and Prevention, 2018).

People with Down Syndrome have a higher obesity prevalence than the general population (Rubin et al., 1998).  In the general population in the United State of America, the Centers for Disease Control and Prevention (1997) reported that 33% of males and 36% of females are overweight (Rubin et al., 1998).  Adults with Down Syndrome have a significantly higher prevalence with 45% of males and 56% of females being overweight (Rubin et al., 1998). However, this higher rate of being overweight was not only found in the United States.  More recently, a study conducted in 2009 found that Dutch children with Down Syndrome have “alarmingly high prevalence rates of overweight and obesity during childhood and adolescence” compared with the general Dutch population (Van Gameren-Oosterom, Van Dommelen, Schönbeck, Oudesluys-Murphy, Van Wouwe, & Buitendijk, 2012).  Compared with the general Dutch population, children with Down Syndrome were more often overweight: 25.5% of boys with Down Syndrome were overweight as compared to 13.3% within the general population, and 32.0% of girls with Down Syndrome were overweight as compared to 14.9% within the general population (Van Gameren-Oosterom et al., 2012).  In addition, children with Down Syndrome were also found to have a higher rate of obesity compared to the Dutch general population. 4.2% of boys with Down Syndrome was found to be obese compared to 1.8% of typically developing children and 5.1% of girls with Down Syndrome were found to be overweight compared to 2.2% of typically developing Dutch children (Van Gameren-Oosterom et al., 2012).

Furthermore, it is found that people with Down Syndrome have an increased risk of having diseases related to overweight conditions (Rubin et al., 1998) and this increased risk starts early.  Children with Down Syndrome have a tendency to become overweight and obese and the rates of obesity among this population are much higher than the general population (Murray & Ryan-Krause, 2010).  These individuals have a propensity for obesity and a large amount of abdominal fat storage,and are subsequently at a higher risk for developing Type 2 diabetes mellitus and may be at a higher risk of experience negative physical consequences associated with obesity (Murray & Ryan-Krause, 2010).  People with Down Syndrome have physiological mechanisms that relate to an increased risk for obesity such as hypothyroidism, decreased basal metabolic rate, increased leptin, poor mastication, and decreased resting energy expenditure (Marray & Ryan-Krause, 2010).

Many of these physiological mechanisms can be regulated to decrease an individual’s risk for obesity (Murray & Ryan-Krause, 2010).  Each child is unique, therefore in order to develop an appropriate prevention and management plan that is tailored to an individual child’s needs, a comprehensive assessment of their complete history must be taken (Murray & Ryan-Krause, 2010).  There are many ways to manage weight, such as encouraging increased physical activity, limiting sedentary lifestyles and eating a balanced diet with vitamin and mineral supplements (Murray & Ryan-Krause, 2010). It is important to remember that not all treatments are effective for all individuals and thus the interventions should be specifically tailored for each child with Down Syndrome (Murray & Ryan-Krause, 2010).  

Obesity, one of the leading causes of preventable death, has been increasing in prevalence throughout the years all around the world (Center for Disease Control and Prevention, 2018).  Unfortunately, there are even higher rates in individuals with Down Syndrome (Center for Disease Control and Prevention, 2018). It is important to continue to pursue research in preventing and educating the general population in regards to overweight and obesity by teaching people about proper nutrition and dietary intake as well as the importance of physical activity in daily life.


Center for Disease Control and Prevention. (2018). Adult Obesity Facts. Retrieved November 12, 2018, from

Murray, J., Ryan-Krause, P. (2010). Obesity in children with down syndrome: background and recommendations for management. Pediatric Nursing, 36(6), 314-9.

Rubin, S.S., Rimmer, J. H., Chicoine, B., Braddock, D., & McGuire, D. E. (1998).  Overweight Prevalence in Persons with Down Syndrome. Mental Retard, 38, 175-181. doi:10.1352/0047-6765(1998)036<0175:OPIPWD>2.0.CO;2

Van Gameren-Oosterom, H. B., Van Dommelen, P., Schönbeck, Y., Oudesluys-Murphy, A. M., Van Wouwe, J. P., & Buitendijk, S. E. (2012). Prevalence of overweight in Dutch children with Down syndrome. American Academy of Pediatrics, 130(6). doi:10.1542/peds.2012-0886


Down Syndrome

A Reflection of Day and Night: Down Syndrome and Sleep

“But I’m not tired” is a common sentence heard by parents as they attempt to tuck their children into bed after a long day. As your child grows up, this phrase may be heard less and less throughout the years. However, for people with Down Syndrome (DS), there may be little change to no change when it comes to not being tired. Complications from DS can make it difficult to enjoy a quality night of sleep.

Sleep problems have been widely reported in children with DS, with over 85% of school-aged children experiencing clinical symptoms of sleep problems (Lukowski & Milojevich, 2017). In a study conducted by Nicole M. Phillips, MD, from the University of Michigan, children with Down Syndrome have more instances of fragmented sleep and frequent awakenings compared to children who do not possess DS. Children with DS also have lower sleep efficiency, fewer total hours of sleep, less REM sleep, and spend more time in a lighter sleep stage than those without DS. A decrease in the quality and amount of sleep can further impair cognitive, behavioral, and physical growth that is already present in DS children (American Academy of Sleep Medicine, 2017).

Children with Down Syndrome often suffer from sleep-disordered breathing such as snoring or sleep apnea because of hypotonia, upper airway restriction and the placement of the tongue. They are also more likely to suffer from sleepwalking, sleep anxiety, and insomnia. Sleep-disordered breathing results in multiple brief sleep disruptions or fragmentations that can reduce the restorative function of sleep and, as a result, increase daytime fatigue (Lukowski & Milojevich, 2017). This fatigue impacts a person’s attentiveness and cognitive abilities during the day. The Journal of Intellectual Disability Research reports that a lack of sleep can also lead to a decrease in physical activity which can lead to obesity, a prevalent feature in those with DS (Chen & Ringenbach, 2018).

Although children and infants have an occasional bout of sleeplessness, these issues decline over time. The same cannot be said for children with DS. Complications for those with down syndrome often create restless nights no matter how tired one is.


American Academy of Sleep Medicine. (2017, November 08). Children with Down syndrome sleep poorly, have more fragmented sleep.

Lukowski, A. F., & Milojevich, H. M. (2017). Sleep problems and temperament in young children with Down syndrome and typically developing controls. Journal Of Intellectual Disability Research, 61(3), 221-232. doi:10.1111/jir.12321

Chen, C. J., & Ringenbach, S. R. (2018). Walking performance in adolescents and young adults with Down syndrome: the role of obesity and sleep problems. Journal Of Intellectual Disability Research, 62(4), 339-348. doi:10.1111/jir.12474

Bipolar Disorder

Connecting Bipolar Disorder with Obesity

Are Obesity and Bipolar Disorder related? In fact, studies show that individuals diagnosed with bipolar disorder are at high risk for being overweight and or obese (McElroy & Keck, 2012). In an 86,028 sample study done by McElroy and Keck, data support the idea that bipolar patients had a higher rate of obesity in comparison to those without bipolar. In addition, medical issues such as being overweight, obese and hyperalimentation were the third most prevalent medical conditions in bipolar individuals. The US National Epidemiologic Survey reported the positive association between obesity and bipolar disorder suggesting that there is a link between the two (Zhao et al., 2016). Since the initial hypothesis, studies show that there is similar brain activity regarding the reward system in both overeating behavior and hypomania, which relates to self-stimulating behaviors and shows that bipolar disorder and obesity share common pathogenic pathways. The question we might all be asking ourselves is: why might this be and what can we do with this information?   

The first culprit we might want to investigate is the medication those with bipolar disorder are being prescribed. However, even after controlling for psychotropic medication use, the relationship between bipolar disorder and obesity still stand (McElroy & Keck, 2012). One hypothesis states that the combination of the two conditions is associated with elevated number of clinical conditions depending on the duration and number of episodes (Goldstein et al., 2011). The study concluded that future research should contribute to the prevention and treatment of obesity because of its burden on bipolar disorder shown with the association between the severity of the disorder and the increased prevalence of obesity (Goldstein et al., 2011).

When studies take a closer look at adolescents with bipolar disorder in comparison to their peers without bipolar disorder, obesity was not more prevalent in individuals with bipolar disorder (Medicalxpress, 2016). Therefore there is a window of opportunity to intervene in order to prevent the increased risk of obesity that is evident in adults. Although being overweight is not more common in adolescents, those who are overweight and bipolar had elevated levels of illness severity, suicide attempts, hospitalization for depression, co-occurrence with conduct disorder and bulimia and increased history of physical or sexual abuse. In an interview with Dr. Goldstein, director of the center for youth bipolar disorder in Toronto’s Sunnybrook Health Sciences Centre, he responded to this finding with the aim of discovering preventative measures for obesity in teens who also have bipolar disorder because the importance of physical and mental health is most significant. With more research, he continued, we should investigate the relationship between the biological, psychological and environmental factors of obesity influencing the severity of bipolar disorder. He concludes the interview with his plans for the subject matter and a question: “wouldn’t it be interesting, and efficient, if an intervention focused on optimizing weight could also yield mental health benefits” (Medicalxpress, 2016)?                    

Although knowledge about the connections between obesity and bipolar disorder is still in the developmental stage, the first line treatment plan for individuals with bipolar disorder and obesity “include psychotropic that efficacious for treating the mood disorder, safe, well-tolerated, and if possible, weight neutral or associated with weight loss” (McElroy & Keck, 2012). Ultimately, at this stage prospective studies are needed to determine whether obesity is a risk factor for bipolar disorder or bipolar disorder is a risk factor for obesity. Strategies for intervention and the promotion of quality of life physically and mentally are also topics for future research.  


Goldstein, B. I., Liu, S.-M., Zivkovic, N., Schaffer, A., Chien, L.-C., & Blanco, C. (2011). The burden of obesity among adults with bipolar disorder in the United States. Bipolar Disorders, 13(4), 387–395.

McElroy, S., & Keck, P. (2012). Obesity in Bipolar Disorder: An Overview. Current Psychiatry Reports, 14(6), 650-658.

Medical X Press. (2016, December 01). Obesity among adolescents with bipolar disorder is linked to increased illness severity. Retrieved January 25, 2017, from

Zhao, Z., Okusaga, O. O., Quevedo, J., Soares, J. C., & Teixeira, A. L. (2016). The potential association between obesity and bipolar disorder: A meta-analysis. Journal Of Affective Disorders, 202 120-123.

Eating Disorders

Obesity: Mental Disorder or Not?

Obesity refers to an excess of body fat that results from the long-term surplus of energy intake relative to energy expenditure (Galgani, 2008). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that obesity is not regarded as a mental illness as compared to anorexia, bulimia, and many other types of eating disorders (“Feeding and Eating Disorders,” 2013). Despite not being an eating disorder, obesity affects more than 1 in 3 Americans (“Obesity,” 2016), meaning that approximately 116 million people in the United States live with obesity.

In modern-day United States, being heavy is seen as the embodiment of gluttony, sloth, and stupidity (Crandall, 2003), while being “thin” or “slender” is the accepted ideal. Though DSM-5 classifies binge eating disorder (BED) as a mental disorder, society illustrates other eating disorders, including anorexia and bulimia, as a struggle to achieve the morality of “thinness.” On the other hand, misinformation about obesity linked to BED suggests an individual’s choice to be mentally ill and something that is brought upon one’s self (Kalb, 2000). As an example, a Newsweek article proposes, “you can’t pick your parents, but you can pick what you eat and how often you exercise” (Barrett Ozols, 2005). By this logic, genetic obesity should be disregarded and instead considered a mere “excuse” for a slew of poor lifestyle choices. While we should take other aspects such as genetic, physiological, and behavioral factors into account, the news media has exacerbated surrounding stigma by depicting obesity as the consequence of an individual’s self-negligence.

Dr. Patrice Harris, former member of the APA Board of Trustees, says that regarding obesity as a disease “will help change the way the medical community tackles this complex issue” (Moran, 2013). A report from the American Medical Association’s Council on Science and Public Health (CSPH) claims that “without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine whether or not obesity is a medical disease state” (Moran, 2013). While a universal definition of disease has not yet been determined, John Seibel, M.D. of the American Association of Clinical Endocrinologists, encourages that “we now have an abundance of evidence identifying obesity as a multi-metabolic and hormonal disease.”

There also exists comorbidity between obesity and a number of mental disorders, including binge-eating disorder, depressive and bipolar disorders, and schizophrenia (“Obesity,” 2016). A group of researchers and peer wellness specialists medically screened 457 adults with severe mental illnesses in four U.S. states; this sample population revealed that 59% of individuals were obese, 25% diabetic, and 19% had both conditions (Cook, 2016). This study also explains that the use of psychotropic medications, high fat-low fiber diets, and sedentary lifestyles as a result of severe mental illnesses can further exacerbate the experience of obesity.

The Eating Disorders Work Group (EDWG) suggests a more biophysiological focus on the dimensions that may underlie both obesity and psychiatric disorders. Given the potential of obesity phenotypes caused by mental disorder, this focus can provide further insight into the role of neural mechanisms in the onset and maintenance of obesity and obesity-related behaviors (“Feeding and Eating Disorders,” 2013). The EDWG advises clinicians to monitor closely the weight and body mass index (BMI) in patients with psychiatric disorders in an effort to combat the negative health outcomes of obesity.

Addressing obesity in a clinical yet culturally appropriate manner has the potential to lower healthcare costs, reduce rates of illness and death attributed to obesity, and raise the quality of life (Marcus, 2012). By changing the viewpoint towards obesity, based on clinical evidence, media evolution, and favorable nutrition and fitness programs, we will especially reduce the physical and psychosocial burdens of the disease.

Remember that although DSM-5 does not classify obesity as a mental disorder, we should not discard the gravity of its effects on the 116 million Americans that live with the disease.


American Psychiatric Association. (2013). Feeding and Eating Disorders. Retrieved from

Barrett Ozols, J. (2005). Generation XL. Newsweek, January 6. Retrieved from

Centers for Disease Control and Prevention. (2016). Obesity. Retrieved from

Cook, J. A., Razzano, L., Jonikas, J. A., Swarbrick, M. A., Steigman, P. J., Hamilton, M. M., … & Santos, A. B. (2016). Correlates of Co-Occurring Diabetes and Obesity among Community Mental Health Program Members with Serious Mental Illnesses. Psychiatric Services, appi-ps.

Crandall, C.S., & Eshleman, A. (2003). A Justification-Suppression Model of the Expression and Experience of Prejudice. Psychological Bulletin 129:414-46.

Galgani, J., & Ravussin, E. (2008). Energy metabolism, fuel selection and body weight regulation. International Journal of Obesity, 32, S109-S119.

Kalb, C. (2000). When Weight Loss Goes Awry. Newsweek, July 3, p. 46.

Marcus, M. D., & Wildes, J. E. (2012). Obesity in DSM-5. Psychiatric Annals, 42(11), 431-435.

Moran, M. (2013). AMA declares obesity requiring treatment. Psychiatric News, American Psychiatric Association. Retrieved from